Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2011 Dec;18(13):3657-65. doi: 10.1245/s10434-011-1832-y. Epub 2011 Jun 17.
Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to examine the relative efficacy of surgical management versus intra-arterial therapy (IAT) for NELM and determine factors predictive of survival.
A total of 753 patients who had surgery (n = 339) or IAT (n = 414) for NELM from 1985 to 2010 were identified from nine hepatobiliary centers. Clinicopathologic data were assessed with regression modeling and propensity score matching.
Most patients had a pancreatic (32%) or a small bowel (27%) primary tumor; 47% had a hormonally active tumor. There were statistically significant differences in characteristics between surgery versus IAT groups (hormonally active tumors: 28 vs. 48%; hepatic tumor burden >25%: 52% vs. 76%) (all P < 0.001). Among surgical patients, most underwent hepatic resection alone without ablation (78%). The median number of IAT treatments was 1 (range, 1-4). Median and 5-year survival of patients treated with surgery was 123 months and 74% vs. 34 months and 30% for IAT (P < 0.001). In the propensity-adjusted multivariate Cox model, asymptomatic disease (hazard ratio 2.6) was strongly associated with worse outcome (P = 0.001). Although surgical management provided a survival benefit over IAT among symptomatic patients with >25% hepatic tumor involvement, there was no difference in long-term outcome after surgery versus IAT among asymptomatic patients (P = 0.78).
Asymptomatic patients with a large (>25%) burden of liver disease benefited least from surgical management and IAT may be a more appropriate treatment strategy. Surgical management of NELM should be reserved for patients with low-volume disease or for those patients with symptomatic high-volume disease.
神经内分泌肝脏转移瘤（NELM）的治疗管理仍存在争议。我们旨在研究手术治疗与经肝动脉治疗（IAT）治疗 NELM 的相对疗效，并确定与生存相关的预测因素。
从 1985 年至 2010 年，9 家肝胆中心共确定了 753 例接受手术（n=339）或 IAT（n=414）治疗 NELM 的患者。采用回归模型和倾向评分匹配评估临床病理数据。
大多数患者的原发肿瘤为胰腺（32%）或小肠（27%）；47%的患者肿瘤具有激素活性。手术组与 IAT 组之间在特征上存在统计学显著差异（具有激素活性的肿瘤：28%比 48%；肝脏肿瘤负担>25%：52%比 76%）（均 P<0.001）。手术组中，大多数患者仅行肝切除术而未行消融术（78%）。IAT 治疗的中位次数为 1 次（范围 1-4 次）。接受手术治疗的患者中位生存时间为 123 个月，5 年生存率为 74%，而接受 IAT 治疗的患者中位生存时间为 34 个月，5 年生存率为 30%（P<0.001）。在倾向评分调整后的多变量 Cox 模型中，无症状疾病（风险比 2.6）与较差的预后密切相关（P=0.001）。尽管对于>25%肝脏肿瘤受累的有症状患者，手术治疗比 IAT 更能提供生存获益，但在无症状患者中，手术治疗与 IAT 后的长期预后无差异（P=0.78）。
无症状且肝脏疾病负担较大（>25%）的患者从手术治疗中获益最小，IAT 可能是更合适的治疗策略。对于低肿瘤负荷的患者或具有高肿瘤负荷且有症状的患者，应保留手术治疗 NELM。
